Articulation Control Mechanisms

ABSTRACT

A surgical access port and method for achieving articulation is disclosed, the surgical access port including a housing, at least one lumen extending through the housing, and an articulation structure. The housing comprises an access member having a proximal end and a distal end, and defines a longitudinal axis. The lumen in the housing extends from the proximal to the distal end of the access member along the longitudinal axis. The articulation structure comprises a first tubular member and a second tubular member, the second tubular member hingably attached to the first tubular member, and an articulation element slidably attached to the first tubular member.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of and priority to U.S. ProvisionalPatent Application No. 61/584,723, filed Jan. 9, 2012, the entiredisclosure of which is incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates generally to surgical instruments for usewith a seal anchor member. More particularly, the present disclosurerelates to articulating surgical instruments usable with a seal anchormember that provides multiple instrument access through a singleincision in a minimally invasive surgical procedure.

2. Description of Related Art

Increasingly, many surgical procedures are performed through smallincisions in the skin. As compared to the larger incisions typicallyrequired in traditional procedures, smaller incisions result in lesstrauma to the patient. By reducing the trauma to the patient, the timerequired for recovery is also reduced. Generally, the surgicalprocedures that are performed through small incisions in the skin arereferred to as endoscopic. If the procedure is performed on thepatient's abdomen, the procedure is referred to as laparoscopic.Throughout the present disclosure, the term minimally invasive is to beunderstood as encompassing both endoscopic and laparoscopic procedures.

During a typical minimally invasive procedure, surgical objects, such assurgical access devices (e.g., trocar and cannula assemblies) orendoscopes, are inserted into the patient's body through the incision intissue. In general, prior to the introduction of the surgical objectinto the patient's body, insufflation gas is used to enlarge the areasurrounding the target surgical site to create a larger, more accessiblework area. Accordingly, the maintenance of a substantially fluid-tightseal is desirable so as to inhibit the escape of the insufflation gasand the deflation or collapse of the enlarged surgical site. In responseto this, various access devices with sealing features are used duringthe course of minimally invasive procedures to provide an access forsurgical objects to enter the patient's body. Each of these devices isconfigured for use through a single incision or a naturally occurringorifice (i.e. mouth, anus, or vagina) while allowing multipleinstruments to be inserted through the device to access the workingspace beyond the device.

During procedures employing multiple surgical instruments through asingle incision access device, it is advantageous to coordinate thepositioning of the end effectors of each surgical instrument. Insituations where one or more of the surgical instruments is anarticulating surgical instrument, manipulating the articulating surgicalinstrument or instruments to coordinate the positions of the endeffectors is desirable.

One example, as disclosed by U.S. Pat. No. 5,520,678, uses control ballsdisposed in a proximal and distal end of a device, such that rotationand pivoting of the proximal control ball is transmitted to the distalcontrol ball and consequently articulates an end effector at the distalend of the device.

Another example, as disclosed by U.S. Pat. No. 5,511,564, is a surgicaldevice having a frame member with a pair of tissue holding mechanisms.An actuator mechanism allows positioning of the tissue holdingmechanisms such that a portion of tissue can be stretched, providing adesirable surgical site.

Yet another example is disclosed in U.S. Pat. No. 5,269,772. A cannulaassembly is disclosed having a tubular member configured to receive alaparoscopic instrument, as well as a second laparoscopic instrumentsuch that both laparoscopic instruments are disposed at an angle in abody cavity and are used in conjunction to perform a laparoscopicsurgery.

However, a continuing need exists for coordinating the end effectors ofarticulating surgical instruments used with an access device thatpermits multiple instruments to be used through a single incision.

SUMMARY

The present disclosure relates to surgical access ports for use inminimally invasive procedures where articulation of surgical instrumentsdisposed in a body cavity is required.

According to one embodiment of the present disclosure, a surgical accessport is provided which includes a housing, at least one lumen extendingthrough the housing, and an articulation structure.

The housing includes an access member having a proximal end and a distalend, and defines a longitudinal axis. The lumen in the housing extendsfrom the proximal to the distal end of the access member along thelongitudinal axis.

The articulation structure includes a first tubular member and a secondtubular member, the second tubular member hingably attached to the firsttubular member, and an articulation element slidably attached to thefirst tubular member.

The articulation element of the present disclosure is envisioned to havemultiple embodiments. In one embodiment, the articulation element willbe a rigid member. This rigid member may have a mating surface that isconfigured to engage a mating surface disposed on the second tubularmember. The mating surfaces, in one embodiment, will have gear teeth.

In another embodiment, the articulation element will be a flexiblemember. In this configuration, the flexible member may be fixablyattached to a distal end of the second tubular member. In anotherembodiment, the flexible member will be configured such that it exerts aforce at the distal end of the second tubular member that is opposite indirection to a force exerted by an operator at a proximal end of theflexible member.

The articulation structure may additionally contain a handle thatextends proximally from the articulation element, through and above theproximal end of the access member.

In other configurations, the articulation element may be disposed eitheron the outside or inside of the tubular members.

The articulation structure is configured such that surgical instrumentsmay be inserted therethrough.

Also disclosed is a method for achieving articulation of surgicalinstruments in a body cavity including inserting the surgical accessport in a body member, inserting surgical instruments through thesurgical access port, engaging the articulation structure such that adesired placement is achieved, and performing a minimally invasiveprocedure.

The method may also include removing the surgical instruments from thesurgical access port, and removing the surgical access port from thebody member.

The various aspects of this disclosure will be more readily understoodfrom the following detailed description when read in conjunction withthe appended drawings.

BRIEF DESCRIPTION OF DRAWINGS

Various embodiments of the presently disclosed articulating surgicalaccess port are disclosed herein with reference to the drawings,wherein:

FIG. 1 is a side perspective view of an articulating surgical accessport disposed in a layer of tissue and including a housing, anarticulation structure, and a handle;

FIG. 2 is a top plan view of the surgical access port of FIG. 1;

FIG. 3 is a bottom plan view of the surgical access port of FIG. 1:

FIG. 4 is a side view of the articulation structure without the housing;

FIG. 5 is a side view of the articulating surgical access port disposedin a layer of tissue, with the articulation structure shown in phantomview;

FIG. 6 is a side view of the articulating surgical access port disposedin a layer of tissue with a surgical instrument inserted through thearticulation structure, both the articulation structure and surgicalinstrument shown in phantom view;

FIG. 7 is a side view of the articulating surgical access port disposedin a layer of tissue with a surgical instrument inserted through thearticulation structure, shown in phantom view, with the articulationstructure having been engaged and the surgical instrument deflected inresponse;

FIG. 8 is a side view of an embodiment of an articulating surgicalaccess port having a surgical instrument inserted therethrough andadditionally having a flexible pusher element;

FIG. 9 is a side view of the embodiment of FIG. 8, with the articulationstructure having been engaged and the surgical instrument deflected inresponse; and

FIG. 10 is a side view of another embodiment of an articulating surgicalaccess port having a second tubular member extending below the accessmember and having a surgical instrument inserted therethrough.

DETAILED DESCRIPTION OF EMBODIMENTS

Referring initially to FIG. 1, a side perspective view of anarticulating surgical access port 100 is shown disposed in a layer oftissue 300. The articulating surgical access port 100 includes an accessmember 110. The access member 110 may have a variety of shapes andprofiles to fit a particular surgical site. In embodiments, the accessmember 110 may have a generally hourglass-shaped profile, and is formedof a compressible element suitable for contact with internal bodysurfaces, such as foam. The access member 110 has a proximal end 110 aand a distal end 110 b, and defines a longitudinal axis A1. The proximaland distal ends 110 a,b of the access member 110 may include rims orflanges to assist in anchoring the surgical access port 100 in a layerof tissue 300.

Turning to FIGS. 2 and 3, the surgical access port 100 is shown in a topplan view and a bottom plan view, respectively. The access member 110includes at least one lumen 120 that extends from a proximal end 110 aof the access member 110, to the distal end 110 b of the access member110. The lumen 120 is configured to widen toward a distal end 110 b ofthe access member 110, such that the lumen exit 120 b is slotted.Disposed within the at least one lumen 120 is an articulation element130, shown in phantom view. The articulation element 130 (FIG. 5) issecurely housed within the access member 110 such that the articulationelement 130 (FIG. 5) will not separate from the access member 110 whenexternal forces are applied to the articulation element 130.

Turning now to FIG. 4, a side profile of the articulation element 130can be seen in detail. The articulation element 130 contains two tubularmembers 140 a,b, with a first tubular member 140 a disposed proximallyof a second tubular member 140 b. The tubular members 140 a,b arehingably attached at a joint 140 c that is typically a hinge, but inembodiments may be a ball-and-socket or other type connection so as toallow for rotation about at least one axis. The tubular members 140 a,bdefine a channel 140 d (FIG. 6) through which instruments may be passed.

The articulation element 130 contains a rigid pusher 150 that mayfurther include a handle 150 a (FIG. 5) that extends proximally abovethe proximal end 110 a of the access member 110. The rigid pusher 150 isdisposed on the tubular members 140 such that it is allowed freedom oftranslation along the longitudinal axis A1. In FIG. 4, the rigid pusher150 is disposed on an outer surface of the tubular members 140. Inembodiments, the rigid pusher 150 may be otherwise disposed on thetubular members 140 a,b, such as embedded within the walls of thetubular members 140 a,b, or disposed on an interior surface of thetubular members 140 a,b.

At a distal end 150 b of the rigid pusher 150 is a first mating surface160 a. This first mating surface 160 a is configured to engage a secondmating surface 160 b on tubular member 140 b. The mating surfaces 160 a,160 b are typically configured as teeth, as shown in FIG. 4, but inembodiments may be any complementary surface that allows for substantialengagement with the distal end 150 b of the rigid pusher 150, such as africtional or grooved surface. Additionally, the second mating surface160 b may be disposed on various locations of the outer surface oftubular member 140 b. As shown in FIG. 4, the second mating surface 160b may be disposed around hinge 140 c. In embodiments, the second matingsurface 160 b may be disposed on another portion of the second tubularmember 140 b.

Generally, distal end 150 b of rigid pusher 150 is unrestricted intranslation along the longitudinal axis A1. However, in embodiments, astop or other mechanism may be employed to prevent overextension of therigid pusher 150 beyond a desired location.

Turning now to FIG. 5, a side view of the articulating surgical accessport 100 is shown with the articulation structure 130 shown in phantomview. The rigid pusher 150 is shown disposed proximally of the hinge 140c. The distal portion 150 b of the rigid pusher 150 is shown configuredas a toothed rack, and in position to engage second mating surface 160b, shown clearly here as a toothed surface on the outer surface of joint140 c. Also shown here is a handle 150 a, operatively connected to thedistal end 150 b of the rigid pusher 150. The handle 150 a is configuredsuch that it is disposed proximally of the proximal end 110 a of theaccess member 110 (and thus external of a body surface 300 a), and canbe readily engaged by an operator of the articulating surgical accessport 100. Also shown is lumen 120, widening toward the distal end 110 bof the access member 110 and terminating at lumen exit 120 b.

Referring to FIG. 6, the articulating surgical access port 100 is shownwith a surgical instrument 400 disposed therethrough (shown in phantomview). The surgical instrument 400 is deformable, yet resilient, and isconfigured to withstand the forces exerted by the tubular members 140a,b during articulation. At a distal end of the surgical instrument 400is an end effector 400 b.

When the operator of the articulating surgical access port 100 engagesthe handle 150 a and applies downward force on the rigid pusher 150 inthe direction of the longitudinal axis A1, the rigid pusher 150translates distally in the direction of the longitudinal axis A1.

The distal translation of the rigid pusher 150 ultimately results inengagement of the first and second mating surfaces 160 a,b Furtherforcing the rigid pusher 150 will cause the second tubular member 140 bto pivot about an axis substantially transverse to the longitudinal axisA1 and disposed through the joint 140 c.

Turning now to FIG. 7, the articulating surgical access port 100 isshown with the rigid pusher 150 having been engaged by an operator, andthe second tubular member rotated about an axis running through thejoint 140 c. The surgical instrument 400, disposed therethrough, isshown deflected in response to the forces exerted by the tubular members140 a,b.

The lumen 120 allows for the freedom of movement of the second tubularmember during articulation. Additionally, the widened lumen exit 120 bat the distal end 110 b of the access member 110 allows the surgicalinstrument 400 and the end effector 400 b to reach points in an internalbody cavity 300 b laterally spaced from the longitudinal axis A1.

Turning now to FIG. 8, an embodiment of an articulating surgical accessport, designated 200, is shown. Similar to the articulating surgicalaccess port 100 discussed above, articulating surgical access port 200includes an access member 110, having a proximal end 110 a and a distalend 110 b, and defining a longitudinal axis A1.

The access member 110 includes at least one lumen 120 that extends froma proximal end 110 a of the access member 110 to the distal end 110 b ofthe access member 110. The lumen 120 is configured to widen toward adistal end 110 b of the access member 110, such that the distal opening120 b of the lumen 120 is slotted.

Articulating surgical access port 200 also includes an articulationmechanism 230. The articulation mechanism 230, similar to articulationmechanism 130 discussed above, includes two tubular members 240 a,bconnected at a joint 240 c. Disposed on the tubular members 240 a,b is aflexible pusher 250. Flexible pusher 250 may be disposed on an outersurface, an inner surface, or embedded within tubular members 240 a,b.Flexible pusher 250 is also fixably attached at its distal end 250 b tothe second tubular member 140 b. Flexible pusher 250 is capable oftranslation along the longitudinal axis A1, and so may be slidablyconnected to the tubular members 240 a,b at points proximal of itsdistal end 250 b. Shown disposed through the tubular members 140 a,b issurgical instrument 400 with end effector 400 b.

In embodiments, the flexible pusher 250 may be disposed on the tubularmembers 140 a,b such that a distal end 250 b of the flexible pusher 250b may reverse direction at a point on the second tubular member 240 b.In this configuration, the flexible pusher 250 will translate a forcesubstantially opposite in direction to a force exerted on handle 250 aby an operator of the articulating surgical access port 200.

Turning now to FIG. 9, the articulating surgical access port 200 isshown with the flexible pusher 250 having been engaged by an operator,and the second tubular member 240 b rotated about an axis through thejoint 240 c. The surgical instrument 400, disposed therethrough, isshown deflected in response to the forces exerted by the first andsecond tubular members 240 a,b.

The lumen 120 allows for freedom of movement of the second tubularmember 240 b during articulation. Additionally, the widened lumen exit120 b at the distal end 110 b of the access member 110 allows thesurgical instrument 400 and the end effector 400 b to reach points in aninternal body cavity 300 b laterally spaced from the longitudinal axisA1.

Referring now to FIG. 10, an embodiment of an articulating surgicalaccess port, designated 300, is shown. The articulating surgical accessport 300 is substantially similar to articulating surgical access ports100,200 discussed above in that it includes an access member 110 havinga proximal end 110 a and a distal end 110 b and defines a longitudinalaxis A1. The access member 110 also contains a lumen 320. However,unlike the previous embodiments, the lumen 320 is not configured toaccommodate movement of internal components. The articulating surgicalaccess port 300 also contains a pair of tubular members 340 a,bconnected at a joint 340 c. Disposed on the tubular members 140 a,b is apusher element 350, which may be rigid or flexible as discussed in theprevious embodiments. The pusher element 350 may further include ahandle 350 a extending proximally of the access member 110. However, thearticulating surgical access port 300 is configured such that the secondtubular member 340 b is disposed distally of and external to the accessmember 110. Thus, when the articulating surgical access port 300 isengaged, second tubular member 340 b is free to pivot about an axissubstantially transverse to the longitudinal axis Al without the needfor a shaped lumen (lumen 120, as in the previous embodiments).

It will be understood that various modifications may be made to theembodiments of the presently disclosed articulating surgical accessports. Therefore, the above description should not be construed aslimiting, but merely as exemplifications of embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the present disclosure.

What is claimed is:
 1. A surgical access port, comprising: a housingcomprising an access member having a proximal end and a distal end anddefining a longitudinal axis; at least one lumen extending through theaccess member from the proximal to the distal end along the longitudinalaxis, the at least one lumen containing at least one articulationstructure, the at least one articulation structure having: a firsttubular member, a second tubular member hingably attached to an end ofthe first tubular member, and an articulation element slidably attachedto the first tubular member.
 2. The surgical access port of claim 1,wherein the articulation element is a rigid member.
 3. The surgicalaccess port of claim 2, wherein the articulation element includes afirst mating surface that engages a second mating surface on the secondtubular member.
 4. The surgical access port of claim 3, wherein thefirst and second mating surfaces are comprised of gear teeth.
 5. Thesurgical access port of claim 1, wherein the articulation element is aflexible member.
 6. The surgical access port of claim 5, wherein thearticulation element is fixably attached to the second tubular member.7. The surgical access port of claim 5, wherein the articulation elementis configured to exert a force at a distal end opposite in direction toa force applied by an operator at a proximal end.
 8. The surgical accessport of claim 1, wherein the articulation element includes a handleextending in the proximal direction.
 9. The surgical access port ofclaim 1, wherein the articulation element is disposed on an outersurface the tubular members.
 10. The surgical access port of claim 1,wherein the articulation element is disposed on an inner surface of thetubular members.
 11. The surgical instrument of claim 1, furthercomprising a surgical instrument disposed through the first and secondtubular members.
 12. A method of achieving articulation, comprising;placing within a site of a minimally invasive procedure a surgicalaccess port, the surgical access port comprising a housing comprising aaccess member having a proximal end and a distal end and defining alongitudinal axis, at least one lumen extending through the accessmember from the proximal to the distal end along the longitudinal axis,an articulation structure disposed in the at least one lumen, thearticulation structure comprising a first tubular member, a secondtubular member hingably attached to an end of the first tubular member,and an articulation element slidably attached to the first tubularmember; inserting surgical instruments through the surgical access port;engaging the actuation member such that a desired placement is achieved;and performing a minimally invasive procedure.
 13. The method of claim12, further comprising the step of removing the surgical instrumentsfrom the surgical access port.
 14. The method of claim 13, furthercomprising the step of removing the surgical access port from the siteof a minimally invasive procedure.
 15. The method of claim 12, whereinthe articulation member is a rigid member.
 16. The method of claim 12,wherein the articulation member is a flexible member.
 17. The method ofclaim 12, wherein the articulation element includes a first matingsurface that engages a second mating surface on the second tubularmember.
 18. The method of claim 17, wherein the first and second matingsurfaces are comprised of gear teeth.
 19. The method of claim 12,wherein the articulation element is a flexible member.
 20. The surgicalaccess port of claim 19, wherein the articulation element is fixablyattached to the second tubular member.
 21. The method of claim 19,wherein the articulation element is configured to exert a force at adistal end opposite in direction to a force applied by an operator at aproximal end.
 22. The method of claim 12, wherein the articulationelement includes a handle extending in the proximal direction.
 23. Themethod of claim 12, wherein the articulation element is disposed on anouter surface the tubular members.
 24. The method of claim 12, whereinthe articulation element is disposed on an inner surface of the tubularmembers.